Provider Demographics
NPI:1497990337
Name:JIMENEZ, ALISON MARTIN (LPC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MARTIN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9400
Mailing Address - Country:US
Mailing Address - Phone:361-728-7760
Mailing Address - Fax:
Practice Address - Street 1:102 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9400
Practice Address - Country:US
Practice Address - Phone:361-728-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62665101YP2500X
NC8647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198282901Medicaid